Healthcare Provider Details

I. General information

NPI: 1710601588
Provider Name (Legal Business Name): HALEY K STEVENSON AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2022
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 S DOBSON RD STE 100
CHANDLER AZ
85224-5603
US

IV. Provider business mailing address

500 W THOMAS RD STE 500
PHOENIX AZ
85013-4220
US

V. Phone/Fax

Practice location:
  • Phone: 602-406-4000
  • Fax: 602-406-6498
Mailing address:
  • Phone: 602-406-4000
  • Fax: 602-406-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number283372
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN178843
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: